title: [Bacterial meningitis: factors related to the delay before appropriate antibiotic administration in the emergency department].
abstract: OBJECTIVE
  We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.
  
  
  METHODS
  Our retrospective observational study (2009-2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.
  
  
  RESULTS
  We included 31 adults presenting with ABM; 29 (93.5%) received ceftriaxone or cefotaxime in the emergency department. Indications for corticosteroids and brain imaging complied with guidelines in respectively 71.0% and 83.9% of cases. The median delays (IQR) were: admission/lumbar puncture (LP), 2h43 [1h09-5h57]; admission/antimicrobials, 3h21 [1h34-5h11]. The indication of suspected ABM in the admission letter was associated with earlier LP (P=0.01), and was almost significantly associated also with faster initiation of adequate antibiotic therapy (P=0.05).
  
  
  CONCLUSIONS
  Suspicion of ABM mentioned in the admission letter was associated to a better management in the emergency department.
authors.affiliation: Urgences médico-chirurgicales adultes (UMCA), CHU Pontchaillou, 35033 Rennes cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Delangle
authors.forename: J
authors.initials: J
authors.lastname: Bouget
authors.forename: M
authors.initials: M
authors.lastname: Vérin
authors.forename: A
authors.initials: A
authors.lastname: Bellou
authors.forename: C
authors.initials: C
authors.lastname: Buscail
authors.forename: M
authors.initials: M
authors.lastname: Perennes
authors.forename: S
authors.initials: S
authors.lastname: Patrat-Delon
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002439:Cefotaxime / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D057210:Delayed Diagnosis; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D002439:Cefotaxime
keywords: Bacterial meningitis; Méningite bactérienne; Professional practice assessment; Évaluation des pratiques professionnelles